Experts: Don’t Say ‘Heartbeat’ to Describe Ultrasound Findings in Early Pregnancy

Some terms commonly used to describe observations seen on ultrasound during first-trimester pregnancies are outdated and should be replaced with more descriptive language, a multisociety panel of ob/gyns, radiologists, and emergency physicians determined.

Terms like “heartbeat” or “heart motion” should be replaced by “cardiac activity,” since cardiac development is gradual and the cardiac chambers are not fully complete by the end of the first trimester, according to Lori Strachowski, MD, of the University of California San Francisco, and colleagues on the panel convened by the Society of Radiologists in Ultrasound.

Rather than saying “pregnancy failure” — a term that didn’t sit well with patients, Strachowski said in a statement — healthcare professionals should refer to “early pregnancy loss,” with relevant modifiers like “concerning for, diagnostic of, in progress, incomplete, and completed.”

The consensus recommendations were co-published in Radiology and the American Journal of Obstetrics and Gynecology.

“Our goal was to establish clear, logical, and respectful terminology to be used for diagnosis and management of first-trimester pregnancy,” the authors wrote, noting that the panelists either agreed unanimously or reached 80% agreement on the preferred terms.

Some terms should be abandoned altogether, including “fetal pole,” “pseudosac,” and “angular pregnancy.” The panel also recommended against using words like “viable,” “live,” or “living,” in part because the terms “may be appropriated by people outside of the field of medicine to support political rhetoric and proscriptive legislation,” the authors wrote.

Additionally, the definition of ectopic pregnancy was expanded to cover any pregnancy implanted in an abnormal location with that location (tubal, interstitial, cervical, etc.) preceding the term “ectopic pregnancy” in a report, along with other descriptive terminology. This allows the inclusion of both extrauterine and intrauterine sites — including cesarean scar implantations — to emphasize the high risk of maternal morbidity and mortality in ectopic pregnancies.

Shuchi Rodgers, MD, of the Sidney Kimmel Medical School of Thomas Jefferson University in Philadelphia and chair of the panel, noted in a press release that many commonly used terms “are outdated or confusing, are used inconsistently, or may be interpreted differently by radiologists, clinicians, and patients.”

The panel prioritized coming to a consensus on terminology that was “clear, specific, scientifically based, and medically appropriate” and acceptable to relevant medical professionals and patients in order to reduce potential bias and harm, Strachowski said.

In their conclusion, the authors noted that “just as advances in transvaginal [ultrasound] have helped revolutionize the care of obstetric patients, the terminology used for optimal interpretation and communication must continue to evolve in a consistent and well-defined manner.”

In an accompanying editorial, Leslie Scoutt, MD, of the Yale School of Medicine in New Haven, Connecticut, and Mary Norton, MD, of the University of California San Francisco, pointed out that more and more patients view imaging reports — not just healthcare professionals.

As such, “it is imperative that reporting language be respectful, supportive, and compassionate without raising false expectations and also reflect patient preference,” Scoutt and Norton wrote. Moreover, they highlighted that “imprecise and inaccurate language may also be misinterpreted by the judicial or legislative systems and result in denial of appropriate, potentially life-saving intervention.”

Christopher Zahn, MD, the American College of Obstetricians and Gynecologists (ACOG)’s chief of clinical practice and health equity and quality, told MedPage Today that “confusion regarding inconsistently used terminology can lead to harmful delays in care, and as ob/gyns, we want to make sure that our patients are empowered with clear information so they can better access the care they need.” He also noted that “this has become even more important since the Dobbs decision, when abortion bans mean that the information in a patient’s record can dictate whether or not they’re able to access needed reproductive healthcare.”

The multidisciplinary panel included members of the Society of Abdominal Radiology, the American College of Radiology, ACOG, the American Institute of Ultrasound in Medicine, the Society for Maternal-Fetal Medicine, the American Society for Reproductive Medicine, the Society of Family Planning, and the American College of Emergency Physicians.

Members of the panel were nominated by their society, invited by the panel chair, and were recruited from across the U.S. to ensure a diversity of perspectives. The panel used a modified Delphi process and looked at existing literature and guidelines on PubMed and Ovid.